Montreal organization looks to follow similar model

On September 30, the Supreme Court of Canada ruled that Vancouver Coastal Health (VCH) would be allowed to continue running InSite for Community Safety, North America’s only supervised injection site.

InSite receives an average of 855 visits and administers about 587 injections per day. There have been 221 overdose interventions and no fatalities, along with over 5,268 referrals to detox or addictions services in 2010.

The Supreme Court ruling comes after attempts by the federal government to shut down InSite based on its presumed violation of the federal Controlled Drugs and Substances Act.

The court ruled that the “federal government’s decision was an infringement of section 7 of the Canadian Charter of Rights and Freedoms, which is the right to life, liberty, and security of the person.”

At InSite, people can inject pre-obtained substances under the supervision of a medical professional, receive free clean injectable supplies (syringes, cookers, filters, water, and tourniquets), and see an addiction counsellor.

British Columbia’s Ministry of Health funds InSite through VCH, which provides the healthcare component while their contracted partner, PHS Community Services Society, provides counselling services.

Out of Vancouver’s $44 million addiction services budget, InSite’s operational budget required only $3 million last fiscal year.

McGill law professor Richard Janda spoke to how InSite operated prior to the court ruling.

“InSite was initially allowed to run under an exemption…but the Minister of Health withdrew it, and the federal government said InSite couldn’t run anymore,” Janda explained.

According to him, the case sets a legal precedent not only as the first supervised injection site, but also because of the “interaction between the Charter of Rights and who has jurisdiction over health matters.”

Janda also noted that, prior to the court ruling, there was confusion over which branch of government had jurisdiction over safe injection sites: provincial governments are in charge of health care, while the federal government in Ottawa controls criminal law. However, in the case of safe injections, the Charter trumped both levels of government.

Janda explained that “the court is saying that, if the federal government fails to protect the Charter, then provincial authorities can come in and do that.”

“If there’s a framework set up by the city or province, the Supreme Court has said that it’s possible [to have such a site],” Janda continued.

This has led to talks of supervised injection sites following the InSite model being opened in the province of Quebec.

Quebec’s Health and Social Services Minister Yves Bolduc told the Globe and Mail that Quebec clinics would not function as “one big single clinic like InSite” but rather “a model that will be socially acceptable, softer” and will meet the needs of the local population.

It is yet to be determined whether a supervised injection site will be opened in Montreal. However, the legal framework to establish one now exists.

The Montreal organization Cactus, which was the first needle exchange program in North America, would like to see a supervised injection site established to supplement its other services, which include counselling, distribution of free birth control and safe sex products, and syringe recuperation.

When asked about a similar clinic opening in Montreal, Anna Marie D’Angelo, senior media relations officer at VCH, explained that “Montreal health officials need to decide for themselves” on the right course of action.

Since InSite opened in 2003, there have been several peer-reviewed studies of its positive effects on the community, including reduced crime and HIV/AIDS rates.

D’Angelo added that InSite also reduces the demand for first responders, such as ambulances and police.

Cailin Rodgers, spokesperson for Health Canada, said that, though disappointed, Health Canada would comply with the court’s decision.

“We believe that the system should be focused on preventing people from becoming drug addicts. Our government believes that spending money on treatment and support to help get people off drugs is the best investment we can make,” said Rogers.

“A key pillar of our National Anti-Drug Strategy is prevention and treatment for those with drug dependencies,” she continued. “As part of the strategy, we have made significant investments to strengthen existing treatment efforts through the Treatment Action Plan.”

D’Angelo spoke about whether InSite condones drug use.

“The doctors and healthcare providers discourage [drug use],” she said, adding that “calling [InSite] safe is incorrect…it is never safe, but in a supervised manner.”